Monitoring adherence to beclomethasone in asthmatic children and adolescents through four different methods
Monitoring adherence to beclomethasone in asthmatic children and adolescents through four different methods
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DOI：
10.1111/j.1398-9995.2009.02037.x
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发表时间：
2009-10-01
期刊：
影响因子：
12.4
通讯作者：
Bousquet, J.
中科院分区：
文献类型：
--
作者：
Jentzsch, N. S.;Camargos, P. A. M.;Bousquet, J.
背景：对于儿童和青少年来说，吸入类固醇的依从性不佳是一个已知问题，即使在父母监督下给药也是如此。本研究旨在通过四种现有方法验证二丙酸倍氯米松（BDP）的依从率。方法：在这项同期队列研究中，随机选择102名3-14岁的哮喘儿童和青少年，随访12个月。每 2 个月根据自我和/或家长报告、药房配药数据、电子设备（Doser (R)；Meditrack Products，哈德逊，马萨诸塞州，美国）监测器和罐重量评估依从率。结果：根据自我和/或家长报告、药房记录、配药器和罐重量对 BDP 的平均依从率为 97.9% (95% CI 88.0-98.6)， 70.0% (95% CI 67.6-72.4)、51.5% (95% CI 48.3-54.6) 和 46.3% (95% CI 44.1-48.4)。 （加药器）和罐重量之间的一致性分析显示，加权 kappa 等于 0.76（95% CI 0.65-0.87）。结论：依从性是一个动态事件，在 12 个月的随访期间，所有方法的依从性均逐渐下降。罐重量和电子监控测量比自我/家长报告和药房记录更准确。这两种方法获得的比率非常接近，统计分析也表明它们之间基本一致。由于与目前可用的电子设备相比，通过罐重量进行测量的成本较低，因此应将其视为评估临床研究和实践中依从性的替代方法。
Background:Suboptimal adherence to inhaled steroids is a known problem in children and adolescents, even when medications are administered under parental supervision. This study aimed to verify the adherence rate to beclomethasone dipropionate (BDP) by four currently available methods.Methods:In this concurrent cohort study, 102 randomly selected asthmatic children and adolescents aged 3-14 years were followed for 12 months. Adherence rate was assessed every 2 months by self and/or parent report, pharmacy dispensing data, electronic device (Doser (R); Meditrack Products, Hudson, MA, USA) monitor, and canister weight.Results:Mean adherence rates to BDP by self and/or parent report, pharmacy records, Doser, and canister weight were 97.9% (95% CI 88.0-98.6), 70.0% (95% CI 67.6-72.4), 51.5% (95% CI 48.3-54.6), and 46.3% (95% CI 44.1-48.4), respectively. Agreement analysis between (Doser) and canister weight revealed a weighted kappa equal to 0.76 (95% CI 0.65-0.87).Conclusions:Adherence was a dynamic event and rates decreased progressively for all methods over the 12-month follow-up. Canister weight and electronic monitoring measures were more accurate than self/parent reports and pharmacy records. Rates obtained by these two methods were very close and statistical analysis also showed a substantial agreement between them. As measurements by canister weight are less costly compared with currently available electronic devices, it should be considered as an alternative method to assess adherence in both clinical research and practice.